Allergic Living » ask the allergistshttp://allergicliving.com
The magazine for those living with food allergies, celiac disease, asthma and pollen allergies.Sun, 02 Aug 2015 22:17:15 +0000en-UShourly1http://wordpress.org/?v=4.1.1Can Skin Exposures Worsen a Child’s Allergy?http://allergicliving.com/2014/01/27/can-skin-exposures-worsen-a-childs-allergy/
http://allergicliving.com/2014/01/27/can-skin-exposures-worsen-a-childs-allergy/#commentsMon, 27 Jan 2014 17:42:55 +0000http://allergicliving.com/?p=19423Q: I have two young children, and my 18-month-old daughter has had an anaphylactic reaction to dairy.

I’ve been letting her older brother continue to eat cheese at lunch, but sometimes he’ll touch or grab his sister’s arm before I can wash him up. This happened recently and she got a few hives. Could skin exposure worsen her allergy? Should we just give up on cheese?

Dr. Sicherer: From a practical and quality-of-life point of view, most families do not ban common allergens (such as milk, egg, soy or wheat) from the home. Rather, they educate themselves on how to ensure the allergic child doesn’t end up ingesting the allergen.

That said, the age of the child is a consideration. An 18-month-old is more likely to grab and eat another child’s food or put contaminated items in her mouth, which is a risk for a severe reaction. Risk also increases when the non-allergic child is too young to understand why he should not share his food with his allergic sibling.

But these risks can be managed. For example, a family meal might include the allergen, while snacks eaten by the children unsupervised by the television exclude it.

The larger question is whether skin or other casual exposure to foods might promote or worsen allergy. One study suggests that higher levels of home exposure to peanut may increase the risk of developing a peanut allergy. This observation matches the knowledge that allergies to cats or pollens, for example, are related to environmental exposure. However, living with a cat to which there is allergy may not necessarily “worsen” the allergy.

To complicate the picture further, there is a study that suggests that the skin may be a route for immunotherapy – a potential treatment for food allergy that is under study. While studies have not adequately addressed the theoretical concern about these types of exposures, it is reassuring that most young children outgrow allergies to many foods that are common in the home, such as egg, milk, wheat and soy.

Most experts would likely agree that for a food such as milk, the theoretical concerns of promoting the allergy through skin contact should be balanced against practical and quality of life issues for the entire family.

Work with your allergist to review the risks and to rationally address ways in which your family can enjoy food while ensuring safety for your allergic child.

Dr. Scott Sicherer is Chief of the Division of Allergy and Immunology of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai in New York. Together with Dr. Hemant Sharma, he writes “The Food Allergy Experts” column in the American Edition of Allergic Living magazine. Questions submitted below will be considered for answer in the magazine.

]]>http://allergicliving.com/2014/01/27/can-skin-exposures-worsen-a-childs-allergy/feed/0Who Is More Likely to Develop Food Allergies Later in Life?http://allergicliving.com/2013/01/11/developing-food-allergies-later-in-life/
http://allergicliving.com/2013/01/11/developing-food-allergies-later-in-life/#commentsFri, 11 Jan 2013 15:17:13 +0000http://allergicliving.com/?p=15730Q. I know that food allergies can crop up later in life. Is that more likely to happen to people with other allergies or asthma, or is it just as likely to happen to someone with no health issues whatsoever?

Dr. Susan Waserman: Most food allergies start in childhood, but you’re right, they can develop at any time in a person’s life.

Factors that favor the development of food allergy in adults include sensitization to pollens and house dust mites, as well as occupational sensitization (which occurs when people who regularly handle and inhale food become sensitized to it due to repeated exposures).

As well, adults with birch pollen allergy may develop “oral allergy syndrome,” which leads those affected to experience itchy mouth when they eat certain raw fruits and vegetables. This is the result of cross-reactivity between the food and the pollen.

A couple of interesting points on this topic:
• Those sensitized to house dust mites may end up with shrimp allergy because both contain the protein tropomyosin.
• Occupational sensitization is also associated with crab and pork allergies.

Dr. Susan Waserman is an allergist and Professor of Medicine in the Division of Allergy and Clinical Immunology at McMaster University in Hamilton, Ont.

We welcome your question to Allergic Living’s Ask the Allergist. Thank you for understanding that the specialists aren’t able to answer every question received.

]]>http://allergicliving.com/2013/01/11/developing-food-allergies-later-in-life/feed/0How can I deal with a child who disobeys food allergy rules?http://allergicliving.com/2013/01/11/how-can-i-deal-with-a-curious-food-allergic-child/
http://allergicliving.com/2013/01/11/how-can-i-deal-with-a-curious-food-allergic-child/#commentsFri, 11 Jan 2013 15:01:23 +0000http://allergicliving.com/?p=15723Q. I have a 5-year-old son who is allergic to dairy, egg, banana, peanuts and other tree nuts. At a recent party, I told him that he could not have a certain kind of cracker being served, as it would make him sick. He grabbed it anyway started to eat it. I made him spit it out and, thankfully, he didn’t react. Something similar happened at a recent birthday party with a cake he was told he could not have.

He was diagnosed with the food allergies when he was 9 months old, and has no recollection of getting sick from the foods. I think he is getting curious, trying to experiment, and I am worried about him at school. Do you have any suggestions about dealing with his curious nature?

Dr. Scott Sicherer: You are describing behaviors that represent age-appropriate natural curiosity and some element of “testing boundaries”. I recommend responding the same way you would if he attempted other dangerous actions such as running into the street or playing with electric sockets. In other words, take stronger actions to ensure he does not eat the avoided food, including extra supervision and placing temptations out of reach.

Reasoning with a 5-year-old about the consequences of the actions is not likely to be fruitful, although it is appropriate to say “Eating the food could make you sick, and we don’t want you to get sick.”

Assuming a child is otherwise developmentally normal, positive reinforcement for appropriate behavior may be helpful, including verbal praise (“We are so proud of our big boy for not touching those cookies”) or a sticker chart (“Look, you got two stickers for twice not touching those cookies and eating your safe ones instead. Now you can choose a special toy to play with”).

One exercise you can try: Ask an adult friend to offer your son food and teach him to say, “No thanks, I have an allergy and my mom or dad has to make sure it is OK.” Provide positive reinforcement when he does a good job. Reading stories about children with food allergies and pointing out how others have restrictions may help him understand and accept the differences, but also recognize that he is mostly doing the same things as others.

Regarding school: At this age, you will need to inform school personnel about his behaviors and discuss approaches to prevent him from grabbing unsafe foods. These would include extra supervision at mealtimes, consideration of his seating with relation to others, and having defined supervised meal or snack times (so that food is not eaten in multiple locations unsupervised), among other measures that are outlined in various state guidelines.

The good news: if your child still has allergies as he gets older, the likelihood of defiant eating should subside – at least until adolescence, but that’s another story.

Dr. Scott Sicherer is Chief of the Division of Allergy and Immunology of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai in New York. Together with Dr. Hemant Sharma, Associate Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington, he writes “The Food Allergy Experts” column in the American Edition of Allergic Living magazine. Questions submitted below will be considered for answer in the magazine.

Dr. Hemant Sharma: This is a great question, and one that many parents of children with cow’s milk allergy have as they search for a suitable substitute for cow’s milk. Unfortunately, because goat’s milk protein is similar in structure to cow’s milk protein, more than 90 percent of the time, the immune system will mistake the two and cause a reaction to goat’s milk or goat’s cheese in someone with a cow’s milk allergy. So goat’s milk is not a safe alternative to cow’s milk, and for the same reason, neither are sheep’s milk nor buffalo’s milk.

You can discuss with your child’s allergist what might be an acceptable cow’s milk substitute. An option for an infant would be an extensively hydrolyzed, cow’s milk-based formula, in which the cow’s milk protein is extensively broken down, making it less recognizable by the immune system and less likely to cause a reaction. Since these formulas are also good sources of nutrients, many allergists will recommend children on restricted diets remain on them beyond the age of one year.

Once ready to wean from a formula, options at that point might include soy milk or rice milk, assuming your child does not also have allergies to those foods. To be sure that all nutritional requirements are being met, it definitely is a good idea to discuss your options with your child’s allergist or a dietitian.

Dr. Sharma is an allergist, clinical researcher and Assistant Professor of Pediatrics. He is Associate Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington D.C. and Director of the Food Allergy Program. He is also the site director for the National Institutes of Health Allergy and Immunology fellowship program. He writes “The Food Allergy Experts” column in the American Edition of Allergic Living magazine. Questions submitted below will be considered for answer in the magazine.

Q. I’m 32 and just had my first anaphylaxis experience to shrimp. It was scary: I was wheezing and could hardly breathe. How can a grown woman suddenly develop a food allergy?

Dr. Scott Sicherer: You are not alone in developing shrimp allergy as an adult. In our U.S. prevalence studies and studies in Canada that tracked peanut, tree nut, fish, shellfish and sesame allergies, shellfish was the most common self-reported allergy.

We know food allergies are affected by the immune system, heredity, environmental factors, and the characteristics of the foods themselves. We know that many food allergies are outgrown, so there are clearly differences between children and adults. What we are missing are the exact details underlying each factor and how the factors interrelate. We only have theories to address your question.

The characteristics of food proteins likely play a role. Proteins responsible for persistent and severe allergies are more resistant to digestion and more likely to be recognized by the immune system. It may be that the child’s immature gut or immune system is more prone to attack the proteins, but shrimp may be an example of a protein that is particularly capable of triggering an immune attack even for adults.

A route of exposure other than through the mouth may be a contributing problem for adult-onset allergy. Most food allergies that begin beyond childhood are mild reactions to raw fruits and vegetables. This type of allergy is called oral allergy syndrome and is related to proteins in pollens. For example, apple shares similar proteins with birch pollen. Thus, becoming allergic to similar proteins in the air starts the trouble.

A theory has also been proposed that environmental exposure to peanut, without actually eating peanut, may increase the risk of peanut allergy. Interestingly, shellfish proteins are similar to ones found in dust mite and cockroach, although most people with those allergies tolerate shellfish.

Next: Digestion Changes

]]>http://allergicliving.com/2012/03/20/adult-shrimp-allergy/feed/0Will our baby develop asthma, too?http://allergicliving.com/2012/03/19/asthma-during-spring/
http://allergicliving.com/2012/03/19/asthma-during-spring/#commentsMon, 19 Mar 2012 21:35:17 +0000http://allergicliving.com/?p=12884Q. My husband has controlled moderate-to-severe asthma. We now have a four-month-old, and I’m concerned that he may develop asthma, too. Should we take any special precautions with the baby during spring allergy season?

Dr. Watson: There are many factors that contribute to the development of asthma in children. Having a mother or father with asthma is only one of the risk factors.

There are studies looking at an index called the Modified Asthma Predictive Index. In children with three or more wheezing episodes, one of which is documented by a physician, major risk factors include family history, personal history of allergy and allergies to inhalant allergens.

You also ask whether taking precautions will prevent asthma. There isn’t enough evidence to support any recommendations. For example, exposure to pets in children has been protective in some studies, yet contributed to the onset of asthma in other studies. For children who developed asthma or hay fever, month of birth seemed a risk factor.

The bottom line is that these are things you really cannot control. If you have pets, there is not enough evidence to say to keep or get rid of them. The only option would be if your child develops symptoms around the pets, then you should give them away.

As far as the springtime, there are no special precautions to protect your child. Watch instead for early symptoms and, should you have concerns, speak to your doctor. As a father of an 18-year-old and a 22-year-old (and an empty-nester), the most important piece of advice I can give you is to relax and enjoy your child.

We welcome your question to Allergic Living’s Ask the Allergist. Thank you for understanding that the specialists aren’t able to answer every question received.

Dr. Wade Watson is a pediatric allergist and Professor of Pediatrics at Dalhousie University. He is also the head of the Division of Allergy at the IWK Health Centre in Halifax.

Dr. Sicherer: The allergic form of eczema, also known as atopic dermatitis, is related to other allergic illnesses including asthma, allergic rhinitis (hay fever) and food allergies. These illnesses are inherited and often occur together in the same person.

Infants and children who are known to be allergic to milk are more likely to have atopic dermatitis and other allergies. Infants with atopic dermatitis are more likely to have positive allergy tests to milk as well as other food and environmental allergens such as dust mite and cat dander.

Milk allergy is not necessarily directly linked with the eczema, but both are more likely to occur in allergy-prone individuals.

The more severe the allergic skin rash and the earlier the onset, the greater the chance that the infant may have, or develop, other allergies, including food allergies. Again, this probably reflects a person’s general allergic inclination, rather than being a direct link between a food and the skin rash.

But could there be a direct link between allergy and eczema? One theory is that the broken, rashy skin allows proteins to be “seen” by the immune system, while normal skin keeps out the allergens. This might make it easier for the immune system to attack the proteins that land on the broken skin, causing more allergies. However, this is just a theory.

One direct link between milk allergy and eczema is when the ingestion of milk actually triggers the rash.

Although milk is sometimes a trigger, there are many common triggers, including skin infection, irritants, the itch-scratch-itch cycle and various allergens in the environment.

Removing milk from the diet as a form of treatment carries nutritional and social risks, so dietary changes should only be done with medical supervision. If medical treatment for atopic dermatitis fails to provide relief, the possibility that milk (or other foods) is a trigger can be explored with an allergist.

Dr. Scott Sicherer is Chief of the Division of Allergy and Immunology of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai in New York. Together with Dr. Hemant Sharma, Associate Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington, he writes “The Food Allergy Experts” column in the American Edition of Allergic Living magazine. Questions submitted below will be considered for answer in the magazine.

]]>http://allergicliving.com/2011/12/12/eczemas-link-to-milk-allergy/feed/0Advice on Reacting to Smell of Peanuthttp://allergicliving.com/2010/08/25/can-i-react-to-the-smell-of-peanutnuts/
http://allergicliving.com/2010/08/25/can-i-react-to-the-smell-of-peanutnuts/#commentsWed, 25 Aug 2010 17:48:36 +0000http://allergicliving.ds566.alentus.com/?p=1800Q. Can I react to the smell of peanuts or nuts?

Dr. Ham Pong: You can be assured that anaphylaxis to airborne food particles is very rare. An allergic reaction to food will not occur because someone is eating it in a classroom or vicinity of the allergic person.

The main reason for advising that the allergenic food not be brought into a classroom is the potential for an allergic child to accidentally ingest some by sharing food. Secondary reasons (less likely to cause anaphylaxis because of the smaller quantities involved) are cross-contamination of desks, toys etc.

The smell of peanut/nuts or peanut butter does not come from the peanut protein, and therefore allergic reactions should not occur just because you smell peanut or because there is an open jar of peanut butter in the area.

Allergic reactions to peanut occur mostly when the peanut enters the body, either by licking it, tasting it or eating it – for instance, bringing it to your lips, mouth directly, or indirectly by transferring it from your hands or other people’s lips to your mouth or eyes.

Therefore, it is important to realize that severe allergic reactions or anaphylaxis to peanut generally occur with eating or tasting peanut, and not by touching or smelling it.

In fact, the smell of peanut should cause no allergic reactions at all, but may make a peanut allergic person feel very uncomfortable because he or she is smelling something that is distasteful and potentially dangerous if eaten. It is likely a defense mechanism to warn the peanut-allergic person to move away from the area, in case they do get into contact with the peanut accidentally.

The only exception to the above is if peanut protein itself is in the air that you breathe. If a peanut allergic person breathes enough of the peanut protein in the air, the person can have a serious allergic reaction, asthma attack or anaphylaxis.

Situations in which this are unusual but can happen. For instance, if a large number of people are opening packages of peanut at the same time – e.g. when peanut packages served on an airplane – and the peanut protein dust gets into the air in an enclosed space.

Other examples would be boiling or frying a food with peanut, as minute peanut particles can then get into the air [through steam or oil particles carrying peanut protein]. Another example could be a floor with large amounts of peanut shells and containing peanut dust where people walking on the shells can stir up peanut dust in the air. (An example would be sports bars.)

However, remember that these reactions might occur only in an enclosed area and with large amounts of peanut dust stirred up in the air, and should not occur with a few peanut shells scattered on the ground, or with one or two people eating peanut next to you. Allergy to inhaled food proteins is rare and may occur in unusual cases. However, it has been reported in some individuals to peanut, wheat, milk, egg, soy, fish, crab.